Antrectomy versus antral preservation in sleeve gastrectomy: a retrospective propensity score analysis of 675 patients
In brief
Sleeve antrectomy adds 5 points of weight loss, with more leaks and bleeding
In a matched retrospective study, patients who had antrectomy lost 32.6% of their body weight at 12 months, versus 27.6% with antral preservation; the weight-loss advantage persisted at 3 years. Antrectomy was also linked to more leaks, bleeding, and new reflux, so the added weight loss must be weighed against these risks.
- Journal
- Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery (Q1)
- Published
- 14 October 2026
- Study design
- Cohort / observational study
- Evidence level
- Level 3, Low (CEBM 3b)
- Authors
- Asyadée Jacob, Wed Alrehaily, Dragos Ciocan, Luigi Luzza, Vanessa De Lorenzi, Gianfranco Donatelli, et al.
- PMID
- 42988643
- DOI
- 10.1016/j.soard.2026.10.002
Why clinicians should know about it
- Picked for Bariatric and Metabolic Surgery (paper of the day, 6 November 2026): Direct sleeve technique comparison, including weight loss, reflux, and complications
Abstract
BACKGROUND: The optimal extent of distal gastric resection during laparoscopic sleeve gastrectomy (LSG) remains debated. Antrectomy may enhance weight loss by increasing restriction, but concerns persist regarding postoperative complications and functional outcomes. Evidence remains limited by small sample sizes and heterogeneous methodologies. The optimal extent of distal gastric resection during LSG remains debated. Antrectomy may enhance weight loss by increasing restriction, but concerns persist regarding postoperative complications and functional outcomes. Evidence remains limited by small sample sizes and heterogeneous methodologies. OBJECTIVES: To compare weight loss, metabolic outcomes, and morbidity between LSG with antrectomy and antral preservation using propensity score analysis. SETTING: University Hospital. METHODS: We conducted a retrospective observational study including consecutive adults undergoing primary LSG between January 2019 and December 2024 at a tertiary bariatric center. Patients undergoing antrectomy (2 cm from pylorus) were compared with antral preservation (≥ 4 cm). Propensity score matching (1:3) used age, sex, and body mass index ≥ 50 kg/m2. Primary outcome was percentage of total weight loss at 12 months. Secondary outcomes included percentage of excess weight loss, co-morbidity resolution, complications, readmission, and mortality. RESULTS: Among 675 patients, 631 were matched (463 preservation versus 168 antrectomy). Follow-up at 12 months was 85.2%. Operative time was longer after antrectomy (80.2 ± 20.6 versus 75.4 ± 24.4 min, P = .033). Early complications tended to be higher (7.8% versus 3.7%, P = .053), specifically for leak (3.0% versus .4%, P = .023) and hemorrhage (3.0% versus .2%, P = .007). Antrectomy achieved higher percentage of total weight loss at 12 months (32.6 ± 8.5% versus 27.6 ± 8.0%, P < .001), sustained at 3 years. Metabolic outcomes were similar, while de novo gastroesophageal reflux disease was more frequent after antrectomy. CONCLUSIONS: Antrectomy during LSG provides greater and sustained weight loss but increases specific postoperative complications and de novo reflux, supporting individualized selection and long-term functional monitoring.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.